ROUNDS


Morning report
Morning report is a review of the night’s activities, of admissions and a hand-over of patients to the day staff. This meeting can be used for education as well as information sharing by reviewing patient assessment and management and highlighting points about the presenting illness. It provides an opportunity for members of the health care team to share ideas and help one another. If there is sufficient time, patient cases can be presented in a more formal manner with broader discussion of medical and patient care issues.

Bedside teaching rounds
Bedside teaching rounds provide an opportunity for the people involved in the care of patients to meet with patients and discuss their illnesses and their management. This approach to teaching uses specific patients to illustrate particular illnesses, surgical procedures or interventions. Individual patients provide a starting point for a broader discussion which does not have to occur at the bedside and could continue later away from the wards. The bedside is also a good place to review clinical skills and specific physical findings.

Traditionally, these rounds have been used for the instruction of junior doctors, but they can also be used for interdisciplinary teaching involving nursing, midwifery and pharmacy staff as well as medical officers. They also give patients and their families an opportunity to ask questions of all the people involved in their care.

Any discussion of a patient on a bedside teaching round must be with the consent of the patient and should actively involve the patient.

Formal educational rounds
Unlike hand-over rounds or bedside teaching rounds, formal educational rounds are a clearly educational event and are separate from the service work of running the wards. They can be organized on a regular basis or when guests with unique experience or expertise are on site.

Morbidity and mortality meetings
Morbidity and mortality meetings are a periodic review of illness and deaths in the population served by the hospital. A systematic review of morbidity and mortality can assist practitioners in reviewing the management of cases and discussing ways of managing similar cases in the future. It is essential that discussions of this kind are used as a learning activity and not as a way of assigning blame.

Team training in critical care practice
If your hospital has a dedicated area to receive emergency patients, it can be helpful to designate time each week for staff to practise managing different scenarios. Have one person pretend to be the patient and work through all the actions and procedures that should take place when that patient arrives at the hospital. Rehearsing scenarios gives people a chance to practise their skills and working together as a team. It also provides an opportunity to identify any further training needs. As a group, decide what roles are needed and what tasks are required of each person. Once this has been decided, post this information for easy reference during a real emergency.

The Annex: Primary Trauma Care Manual provides a structured outline for a short course in primary trauma care that can be used for staff, including medical, nursing and paramedical staff.

Hospital library
Store educational and resource materials together in a central place to which staff seeking information have easy access. If the hospital has a visitor who offers teaching on a specific topic or if people present useful information at educational rounds, designate someone to make notes and include them in the library. If possible, keep interesting X-rays and notes on unusual cases.

Designate a specific person to be responsible for the care and organization of the collection, including making a list of materials and keeping a record of items that are borrowed in order to ensure their return. Make known your interest in developing a library of learning materials to any external organizations or donor agencies with whom your hospital has contact and make specific requests and suggestions for books, journals and other resources.